Objectives The aim of this meta-analysis is to perform an up-to-date assessment on short-term and long-term effectiveness of PCI for CTO recanalisation.
Despite advances in procedural techniques and expertise, percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) in select patients remains a challenge. Recently, several observational studies which compared successful CTO with PCI versus failed CTO procedures have controversial outcomes.
Methods We conducted with a search of PUBMED, ELSEVIER, and CLINICAL.COM and had concluded all of published studies, from January 2000 until July 2012, which compared PCI treatment of successful CTO to failed CTO procedures.
Results A total of sixteen observational studies enrolling 10,256 patients (7,320 patients in successful CTO and 2,936 patients in failed CTO group) were included. Compared with failed CTO, successful CTO recanalisation group significantly reduced all-cause death (3.6% vs. 8.2%; P < 0.00001), cardiac death (2.6% vs. 6.0%; P < 0.00001), major adverse cardiac event (MACE; 10.1% vs. 20.6%; P < 0.0001) and subsequence coronary artery bypass surgery (3.4% vs. 17.1%; P < 0.00001) in the overall population, and these benefits were sustained in studies which more than 2 years follow-up. Meanwhile, in the overall population, the risk of myocardial infarction (MI) was reduced in successful CTO group (4.0% vs. 5.9%; P = 0.02), but there was a trend in studies with more than 2 years follow up in successful PCI CTO (P = 0.09). In addition, successful CTO improved quality of life (P = 0.0001), reduced both MACE (P < 0.00001) and mortality (P = 0.004) in patients with multivessel disease, and also resulted in lower rate of death in patients with single vessel disease (SVD; P = 0.02), but had no different MACE events in SAD patients (P = 0.07). However, although successful CTO group had a low rate of repeat revascularisation in studies with more than 2 years follow-up (P = 0.03), it increased the in-hospital revascularisation events (P = 0.007) and there was no difference in overall population (13.6% vs. 16.0%; P = 0.40).
Conclusions Base on this meta-analysis, successful PCI recanalisation may be considered a efficacious option for the patients with CTO lesions and should be comfirmed by future randomised trials.